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目的:探讨影响局部复发性骨肉瘤患者预后的相关因素。方法:2002年1月—2009年12月本科共收治并确诊骨肉瘤患者339例,回顾性分析其中56例局部复发性骨肉瘤患者的临床资料,并对其预后进行随访,随访时间为13～130个月,平均45.1个月。以性别、年龄、肿瘤部位、肿瘤大小、手术方式、新辅助化疗、第1次术后辅助化疗次数、肺转移、其他部位远处转移和局部复发后治疗这10项因素作为变量,应用Kaplan-Meier法计算患者总生存率和复发后生存率,应用log-rank检验进行预后的单因素分析,应用COX回归模型进行预后的多因素分析。结果:56例局部复发性骨肉瘤患者局部复发后的中位生存时间29个月(95%可信区间:24.5～33.5),总的中位生存时间为51个月(95%可信区间:29.3～72.7),累计2年和3年生存率分别为78.6%和46.4%。单因素分析显示,性别、肿瘤大小、肺以外其他部位转移和局部复发后治疗方案是局部复发性骨肉瘤的预后因素(P<0.05);多因素分析显示,肺以外其他部位转移和局部复发后治疗方案是影响预后的独立相关因素(P<0.05)。年龄、肿瘤部位、手术方式、新辅助化疗、第1次术后辅助化疗和肺转移与复发性骨肉瘤的预后无关(P>0.05)。结论:肺以外其他部位转移和局部复发后治疗是影响局部复发性骨肉瘤患者预后的独立影响因素,对局部复发灶和远处转移灶采用积极的外科治疗能够有效地提高局部复发性骨肉瘤患者的生存率。
Objective: To investigate the related factors affecting the prognosis of patients with locally recurrent osteosarcoma. Methods: From January 2002 to December 2009, 339 patients with osteosarcoma were admitted to our hospital and the clinical data of 56 patients with locally recurrent osteosarcoma were retrospectively analyzed. The prognosis was followed up for 13 ~ 130 months, an average of 45.1 months. Ten variables including gender, age, tumor location, tumor size, operation method, neoadjuvant chemotherapy, the number of postoperative adjuvant chemotherapy, lung metastasis, distant metastasis of other sites and post-local recurrence were used as variables. Kaplan- Meier method was used to calculate the overall survival rate and post-recurrence survival rate. Log-rank test was used to predict the prognosis of univariate analysis. COX regression model was used to predict the prognosis of multivariate analysis. RESULTS: The median survival time was 56 months (95% confidence interval: 24.5-33.5) after local recurrence in 56 patients with locally recurrent osteosarcoma and the median overall survival was 51 months (95% confidence interval: 29.3 ~ 72.7). The cumulative 2-year and 3-year survival rates were 78.6% and 46.4% respectively. Univariate analysis showed that the treatment regimen of gender, tumor size, metastasis of other parts of the lung and local recurrence were prognostic factors of local recurrent osteosarcoma (P <0.05). Multivariate analysis showed that the metastasis and local recurrence of other parts of the lung Treatment regimen was an independent factor influencing prognosis (P <0.05). Age, tumor location, operation method, neoadjuvant chemotherapy, first postoperative adjuvant chemotherapy and lung metastasis had no correlation with the prognosis of recurrent osteosarcoma (P> 0.05). Conclusion: The treatment of metastasis to other parts of the lung and local recurrence is an independent factor affecting the prognosis of patients with locally recurrent osteosarcoma. The positive surgical treatment of local recurrence and distant metastasis can effectively improve the local recurrence of osteosarcoma patients The survival rate.